A City, If You Can Keep It: Collateral damage

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For every 2.65 – 4.37 people who die of COVID, we are killing one person. For every 1.75 people who die of COVID we are killing one business.

As my wife will tell you (if you buy her a glass of Turkovich Tempranillo on their new patio), for months now I have been talking anyone’s ear off who will listen that we need to be taking a big picture perspective to our COVID response. COVID cases, hospitalizations, and deaths cannot be the only concern when our elected and unelected representatives dictate a course of action.

Enter the CDC’s excess deaths dataset. Excess deaths this year should give us a perspective on the impact of our response to COVID. We initially took a pretty extreme course of action, mandating everyone stay home for weeks, all businesses close, and no one go to the doctor unless they were dying or had COVID. Without looking at any numbers, it is reasonable to assume people would die preventable deaths in that time period of uncertainty and extreme response.

Prior to this year, the last time we had excess deaths was the December 2017 – January 2018 flu season. From March – Aug. 29 (the latest complete week for all CDC data sets I used, remember our reporting lag discussion the other week) we had 174,772 COVID deaths, and between 188,761 confirmed and 250,655 estimated excess deaths above the expected amount. The difference between COVID deaths and excess deaths allows us to measure the externalities of our response. This is about the point where my wife is reading and telling me I’m losing her with data so I will cut to the end: between 39,995 and 65,920 estimated people above the expected deaths have died this year that did not have COVID. After finishing my calculations and first draft of this column, a friend showed me a source online working this same problem that is claiming non COVID deaths are as high as 105,000.

Two explanations of the non COVID excess deaths make sense to me. Either people died avoidable deaths due to lack of access to care/not knowing they could access it/isolation, or those deaths are COVID deaths that were not recorded as COVID. The latter is unlikely since COVID detection is almost the only thing being focused on. Absent a third hypothesis, we have to assume the potentially 65K deaths are unintended results of lockdowns and restrictions.

Now this is when we ask ourselves: If we had taken a less extreme course of action, would 65,000 more people have died of COVID? What percent higher would our death count be if we had taken a less extreme course of action? Would it be higher at all? How many more non COVID deaths from Dementia, Alzheimer’s, suicide, depression will we put up with? I postulate that unless our hospitals were unable to admit patients, the COVID death count to date would be fewer than 65,000 higher than we see now.

And what about businesses? The latest number I could find estimated 100,000 businesses closed forever. How many jobs is that? How many employer provided health plans? How many families and children are now suffering from food insecurity because their job no longer exists? How many lifetimes of blood sweat and tears were all for naught through no fault of their own? How many more can we abide?

We have no way to measure what we have gained by locking down our fellow Americans and restricting our businesses. NO ONE can tell you that we saved X number of lives because that would be knowing the unknowable. But we can measure the collateral damage in lives, livelihoods, and futures. We can also pinpoint the people at risk of death IF they contract COVID-19, as well as those more likely to required hospitalization.

Our response was formulated when the projections said total deaths would be in the millions with hospitals completely overwhelmed, people dying in the streets. I think we can all agree the initial response in March was appropriate for the projections at the time. It was quickly apparent those projections were off by orders of magnitude. Once it was clear we were in no danger of overwhelming hospitals, the broad-brush approach we are STILL using should have transitioned to a targeted protection of the people with 2.6 co-morbidities over the age of 55 without taking a wrecking ball to everything else.

For every 2.65 – 4.37 people that die of COVID, we are killing one person. For every 1.75 people that die of COVID we are killing one business. And those seem like unacceptably high collateral damage rates to me.

Columnist Note
This week’s column was finished above, but I think the following is necessary: The title of my column “A City, if you can keep it” was my wife’s idea. A play on words from the Benjamin Franklin quote “A Republic, if you can keep it.” I had the privilege to be invited to attend a meeting last week about where we go from here and what relief our elected representatives can provide.

The meeting left me even more frustrated with our current situation than I was before, heartbroken for our business owners in town, and angry at the lack of empathy and urgency they received. I never expected the title of this column to become a succinct commentary on our city’s future. The current restrictions we are living under are unsustainable. Everyone with half a brain knows it, few seem willing to say it on record.

We have a city, a wonderful city. We all need to do something to fight to keep it. I have chosen my course of action to help, what will yours be?

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